Program shows success with pay for performance

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Pilot programs that reward doctors and hospitals for performance and quality medicine pay off in terms of financial savings and patient health.

During the past five years, the Centers for Medicare and Medicaid Services has been rewarding doctors in private practice, as well as hospitals, for improving the quality of care and reducing the effects of chronic disease — saving money for CMS and the Medicare Trust Fund

The hospital program works in conjunction with Premier Inc., a national hospital quality measurement organization.

The project started during 2003 with hospitals in 38 states, and was designed to test payment incentives to see if they would improve the safety, quality and efficiency of inpatient services.

Participants raised overall quality by an average of 17 percent during four years, based on their performance on more than 30 care measures in five areas: heart attack, coronary bypass graft, heart failure, pneumonia, and hip and knee replacements.

The program is awarding incentive payments totaling $12 million to 225 hospitals for top performance and top improvements.

During the first four years, CMS awarded more than $36 million to top performers. The program will continue another two years.

Ten groups participated in the large-group physician practice, with two achieving top performance levels on all 32 measures.

During the first three years, doctors increased their quality scores an average of 10 percent on diabetes measures, 11 percent on congestive heart failure measures and 6 percent on seven coronary artery disease measures.

Doctors in this group earned performance payments of $25.3 million as part of their share of $32.3 million in savings generated for the Medicare Trust Fund.

More than 560 doctors in small practices earned payments — almost all of the 610 participating doctors. CMS is awarding $7.5 million in incentive payments to practices in California, Arkansas, Massachusetts and Utah. The average payment is $14,000, but some practices earned as much as $62,500.

Based on the success of these programs, CMS plans to launch incentive programs for nursing homes hospital collaboration and for collaboration between hospitals and doctors.

St. Francis marks first year

Colorado Springs’ newest hospital is marking its first year in business with a $70 million net patient revenue and an additional $2.6 million in salaries.

St. Francis Hospital, at Woodmen Road and Powers Boulevard, opened during August, 2008, and the Centura system closed most of Penrose Community Hospital.

That building is for sale, but the system still operates an urgent care clinic for people in the Village 7 neighborhood.

“We’ve hired about 60 new people at St. Francis, and 10 new people at the urgent care clinic,” said Nate Olsen, CEO at St. Francis. “Our services have changed as business increases.”

He said that daily bed numbers increased 30 percent at St. Francis compared to Penrose Community.

“We’re adding 15 beds to the Medical Surge Unit, because that’s where we’re seeing a large increase in patients,” he said. “We’re also working to add two rooms to the emergency room.”

Olsen said he believes St. Francis sees more patients from areas outside Colorado Springs because of the hospital’s location.

“Emergency and ambulance crews from other towns come here, because it’s closer than driving downtown,” he said. “It saves about an hour, and since a lot of them are volunteers, it makes a big difference.”

Inadequate staffing

More than seven in 10 nurses said that staffing levels are not adequate for patient demand — and more than half said they are considering leaving their position because of it.

The American Nurses Association conducted the poll, which drew more than 15,000 responses from nurses. About 42 percent of the nurses who expressed dissatisfaction said they were planning to leave their positions because of inadequate staffing.

“These results confirm what we have long been hearing from registered nurses: that unsafe staffing in their units is their top concern,” said Rebecca Patton, president of the association. “When obligations to our patients are compromised because there are not enough nurses on hospital units to provide the highest quality of care. Registered nurses are understandably frustrated.”

The poll also revealed that nurses are in a severe time-crunch during their work hours.

Nearly one-quarter said their schedule rarely allows them to take a full meal break. Two-thirds said they must perform non-nursing activities, such as delivering meals, transporting patients and making pharmacy runs.

The nurses said that quality of care has declined during the past year, and nearly half said they would not feel confident having a friend or family member receive care in the facility at which they work.

Amy Gillentine covers health care for the Colorado Springs Business Journal.